Provider Demographics
NPI:1639619471
Name:TUCCILLO, DANIELLE (OT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TUCCILLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2126
Mailing Address - Country:US
Mailing Address - Phone:347-645-3372
Mailing Address - Fax:
Practice Address - Street 1:2830 STEVENS ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2126
Practice Address - Country:US
Practice Address - Phone:347-645-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021294225X00000X
FL18348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist